Chapter 52: The Child With a Neurologic Alteration

Key structural considerations include open fontanels and incomplete myelination, both of which affect neurological assessment and clinical outcomes in children. The chapter emphasizes intracranial pressure management through the Monro-Kellie doctrine, establishing that any increase in cranial vault contents demands careful monitoring using the Pediatric Glasgow Coma Scale as a modified assessment tool for pediatric patients. Congenital neural tube defects, particularly spina bifida and associated myelomeningocele, are linked to maternal nutritional factors such as folic acid insufficiency, with implications for long-term multidisciplinary treatment planning. Hydrocephalus is presented as a pathological accumulation resulting from cerebrospinal fluid imbalance, often requiring ventriculoperitoneal shunt placement to restore normal fluid dynamics. The chapter classifies cerebral palsy as a chronic nonprogressive motor disorder with multiple phenotypes including spastic, dyskinetic, and ataxic presentations, while acknowledging comorbid seizure activity and cognitive involvement. Traumatic brain injury mechanisms are explained through acceleration-deceleration forces causing axonal shearing, with emphasis on concussion recognition and structured return-to-play guidelines to mitigate recurrent injury risk. Seizure management encompasses classification by seizure origin, emergency protocols for status epilepticus, and emerging therapeutic options including metabolic and neuromodulatory interventions. The chapter concludes by addressing acute infectious complications such as bacterial and viral meningitis, which present with characteristic meningeal signs, alongside autoimmune conditions like Guillain-Barré syndrome characterized by progressive ascending motor weakness requiring critical care monitoring and supportive ventilation strategies.